Comparison of the recovery quality between remimazolam and propofol after general anesthesia: systematic review and a meta-analysis of randomized controlled trials

PeerJ. 2024 Aug 26:12:e17930. doi: 10.7717/peerj.17930. eCollection 2024.

Abstract

Introduction: To evaluate the recovery quality between remimazolam and propofol after general anesthesia surgery.

Methods: We included eligible randomized controlled trials (RCTs) in EMBASE, PubMed, Cochrane Central, Scopus, and Web of Science up to June 26, 2024 for comparison the recovery quality of remimazolam and propofol after general anaesthesia. The primary outcomes were the total Quality of Recovery-15 (QoR-15) and five dimensions of QoR-15 on postoperative day 1 (POD1). Secondary outcomes were adverse events, the Quality of Recovery-40 (QoR-40) on POD1, and the intraoperative and postoperative time characteristics.

Results: Thirteen RCTs with a total of 1,305 patients were included in this meta-analysis. Our statistical analysis showed that remimazolam group had higher QoR-15 score on POD1, with no significant difference (Mean Difference (MD) = 1.24; 95% confidence interval (CI), [-1.67-4.15]; I2 = 75%; P = 0.41). In the five dimensions of QoR-15, remimazolam group was superior to propofol group in terms of physical independence (MD = 0.79; 95% CI [0.31-1.27]; I2 = 0%; P = 0.001). Remimazolam group was lower than propofol group in incidence of hypotension (Risk Ratio (RR) = 0.48; 95% CI [0.40-0.59]; I2 = 14%; P < 0.00001), bradycardia (RR = 0.18; 95% CI [0.08-0.38]; I2 = 0%; P < 0.0001) and injection pain (RR = 0.03; 95% CI [0.01-0.12]; I2 = 48%; P < 0.00001), respectively. The intraoperative and postoperative time characteristics and the QoR-40 were similar in the two groups.

Conclusions: Our analysis showed that the recovery quality of the remimazolam group after general anaesthesia was similar to propofol group, while the incidence of adverse events was low in remimazolam group. As a potential anesthetic, remimazolam can be used in place of propofol for surgical general anesthesia.

Keywords: General anaesthesia; Meta-analysis; Propofol; QoR; Quality of recovery; Remimazolam; Systematic review.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Comparative Study

MeSH terms

  • Anesthesia Recovery Period*
  • Anesthesia, General* / adverse effects
  • Anesthetics, Intravenous / administration & dosage
  • Anesthetics, Intravenous / adverse effects
  • Benzodiazepines* / administration & dosage
  • Benzodiazepines* / adverse effects
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use
  • Propofol* / administration & dosage
  • Propofol* / adverse effects
  • Randomized Controlled Trials as Topic

Substances

  • Anesthetics, Intravenous
  • Benzodiazepines
  • Hypnotics and Sedatives
  • Propofol
  • remimazolam

Grants and funding

This research was funded by the National Natural Science Foundation of China (82102372); Natural Science Foundation of Shandong Province (No. ZR2023MH264); Zibo Medical and Health Research Project (20231901134). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.